임신 중 복강경 수술 지침 - 의학 (Medicine)

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====== Laparoscopy Pregnant ======

=====시기=====
최근 신뢰할만한 연구에 의하면 임신 주수에 상관없이 안전한 숫술이 가능하다.
과거에는, 발생 가능한 합병증을 줄이기 위하여 임신 일분기와 삼분기에는 수술을 피하였다. 그래서 보통 임신 26~28주가 한계로 여겨졌다.

=====방법=====
  * Local anesthesia was utilized in port sites for improved postoperative analgesia, which minimized narcotic requirements after surgery. 
  * A modified Hasson technique was used for initial entry and insufflation via direct visualization of the fascial opening and trocar insertion without use of blindly inserted insufflation devices. Initial entry was a supraumbilical (or subxiphoid), modified Hasson, open-fascia technique under direct vision. The fascia, elevated by a towel clip, was incised in the midline sufficiently to pass a 10-mm cannula (with the trocar removed) directly into the abdomen, angled away from the visible uterus. Ultrasound was not required in order to identify the uterus. 
  * Patients were turned slightly to their left to minimize uterine compression of the vena cava, and low-level insufflation pressures were maintained throughout the procedures.
  * Fetal heart tones were checked preoperatively, again after induction of anesthesia, upon completion of the operation, in the recovery room, and every 4 hours until discharge the next morning. 
  * Uterine contraction monitoring was done every 4 hours and if the patient reported unusual pain or contractions. Tocolytic agents were not utilized prophylactically. 
  * All patients were monitored overnight for uterine irritability and fetal heart tone checks.

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